title: Anterior decompressive surgery after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament.
abstract: BACKGROUND
  Two surgical procedures, posterior decompressive surgery (PDS) and anterior decompressive surgery (ADS), are the treatment options for cervical ossification of the posterior longitudinal ligament (OPLL). Each procedure has advantages and disadvantages. Cervical laminoplasty, a type of PDS, is relatively easy to perform and can be used for patients with multilevel cord compression. ADS can often be more technically demanding.
  
  
  OBJECTIVE
  The purpose of this study was to clarify the clinical characteristics and surgical results of the patients for whom ADS was necessary after PDS.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  A total of 144 patients, followed for more than 3 years after cervical laminoplasty, were included. The neurologic status was graded using the Japanese Orthopedic Association (JOA score). Eleven patients underwent ADS after PDS. The clinical background and surgical outcomes were evaluated. Radiological findings of the 11 patients requiring ADS after PDS (PA group) and the 133 PDS patients not requiring ADS (P group) were compared.
  
  
  RESULTS
  In the PA group, the JOA score was slightly deteriorated during follow-up after cervical laminoplasty. Severe pain in the unilateral upper extremity and deterioration of cervical myelopathy were the most typical symptoms necessitating ADS. The incidence of the mixed type of OPLL was significantly higher in this group. The JOA score improved in all patients after ADS as a second surgery.
  
  
  CONCLUSIONS
  In our strategy for the surgical treatment of cervical OPLL, PDS with laminoplasty remains as the initial treatment, and in patients with neurological deterioration and newly developed clinical symptoms during follow-up, ADS is considered as a salvage procedure.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan. Electronic address: zenji@med.u-toyama.ac.jp.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Kawaguchi
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Yasuda
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Seki
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hori
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.
authors.forename: Tomoatsu
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D065406:Laminoplasty / Q000379:methods*; D017846:Longitudinal Ligaments / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000601:surgery*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anterior surgery; Cervical laminoplasty; Cervical myelopathy; OPLL; Reoperation